Why We Oppose Question 1: Mental Health Counselor Voices Her Concerns

In November 2018, Massachusetts residents will vote on ballot Question 1, a proposed law that would limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities. This will be devastating for behavioral and mental health facilities. Concerned by the negative impact that this proposed law would have on overall patient care, McLean has come out publicly in opposition to Question 1.

Reasons behind this opposition are detailed in a recently issued statement from McLean Hospital and a white paper prepared by the Massachusetts Association of Behavioral Health Systems. McLean nurses and other staff are also speaking publicly about why they oppose Question 1. We will be featuring these narratives during the weeks leading up to Election Day voting on November 6, 2018.

Ballot Question 1 is nothing if not confusing. In a profession that prides itself on individuals making informed choices, the rhetoric is deceptively chaotic and misleading. Everyone in health care wants nurses to be treated with respect and have manageable caseloads. However, the primary goal is to provide high-quality care. Watching TV ads and listening to the radio, it appears that health care facilities and their management teams are ignoring the needs of nursing staff, which would ultimately affect patients. But reading the Secretary of the Commonwealth’s 2018 Information for Voters booklet left me with more questions than answers.

Per the booklet, a “yes” vote, would limit the number of patients that could be assigned to one registered nurse in hospitals or certain other health facilities. Here are some of my concerns with that arrangement:

• Where would people go when there aren’t enough nurses?
• It appears that the law does not have any waiver provisions, and since we are in New England, I wonder what will happen when there are weather emergencies?
• What happens during non-peak hours and when people are sleeping? I see no provisions in the law that would allow hospitals and certain other health care facilities to make staffing adjustments when a higher patient-to-nurse ratio may not present an appreciable increase in risk.
• Per the Massachusetts Secretary of the Commonwealth office’s statement of fiscal consequences, “This proposed law may affect both state and municipal revenues and expenditures, with state-owned hospitals required to expend between an estimated $67,800,000 and $74,800,000 annually to comply with the proposed law, and the Health Policy Commission required to expend an estimated $1,281,200 annually to monitor compliance. There will also be an impact on MassHealth, the state’s Medicaid program, and state-funded employee and retiree health care obligations to the extent that the initiative increases hospital costs or causes hospital closures.” (p. 5 of the Massachusetts 2018 Information for Voters booklet). This is an unfunded mandate!

Each voter should make an informed choice, but I know the people I work with already have difficulty getting practitioners and providers that will accept their insurance, especially MassHealth or Medicaid. I have a big concern that this law will likely make that worse. Finally, bills will need to be paid, and cost-cutting measures would need to be implemented. Where will that leave you? Where will it leave the people we are dedicated to serve? Fewer services? Fewer providers? Longer waiting times when in crisis or experiencing an emergency is an unacceptable standard of care. For me, the decision is clear. I choose better care. I vote “NO!”

Jenn L. Hinde, LMHC-BC, CESP, is a vocational rehabilitation specialist at Waverley Place, a community-based support program that provides a therapeutic community for adults experiencing severe mental illness, including conditions such as schizophrenia and bipolar disorder.